contemplative practice

Mindfulness is a Cost-Effective Treatment for Fibromyalgia

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Mindfulness is a Cost-Effective Treatment for Fibromyalgia

 

By John M. de Castro, Ph.D.

 

“Mindfulness as a practice of conscious meditation affects brain activity, achieving, on the one hand, deactivating the areas of negative pain assessment and, on the other, activating those related to the healing and resilience processes. In this way, it helps calm the sympathetic nervous system, which usually leads to reduced stress levels, on the one hand, and also the sensation of perceived pain.” – Andres Martin

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers. Clearly, fibromyalgia greatly reduces the quality of life of its’ sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, mindfulness may reduce worry and catastrophizing and thereby reduce fibromyalgia pain and improve the quality of life.

 

The effectiveness of mindfulness training for the treatment of fibromyalgia pain has been established. But whether it is cost-effective relative to other treatments has not been investigated. In today’s Research News article “Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study).” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678679/), Pérez-Aranda and colleagues examine the cost-effectiveness of Mindfulness-Based Stress Reduction (MBSR) training for the treatment of fibromyalgia.

 

They recruited adult fibromyalgia patients and continued treatment as usual. The patients were then randomly assigned to receive once a week for 2 hours for 8 weeks either Mindfulness-Based Stress Reduction (MBSR) or relaxation and Fibromyalgia education, or were assigned to receive no additional treatment as. The MBSR program consisted of meditation, yoga, body scan, and discussion. The patients were also encouraged to practice at home. They were measured before and after the intervention and 12 months later for health-related quality of life, current health status, medications, and health services.

 

They found that over the year following treatment there were significant increases in the patient’s quality of life and their current health status for the Mindfulness-Based Stress Reduction (MBSR) group but not for the fibromyalgia education or treatment as usual groups. In addition, there was a significant reduction in total healthcare costs including the costs of the interventions for the MBSR group only. The largest reduction in costs for the MBSR group was in primary healthcare costs. So, MBSR training reduced treatment costs and increased the health-related quality of life of the fibromyalgia patients. Hence,  MBSR training is a safe, effective, and very cost effective treatment for fibromyalgia.

 

So, mindfulness is a cost-effective treatment for fibromyalgia.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Pérez-Aranda, A., D’Amico, F., Feliu-Soler, A., McCracken, L. M., Peñarrubia-María, M. T., Andrés-Rodríguez, L., … Luciano, J. V. (2019). Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study). Journal of clinical medicine, 8(7), 1068. doi:10.3390/jcm8071068

 

Abstract

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost–utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention (“FibroQoL”) and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost–utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678679/

 

Improve the Behavior of Prisoners and Prison Staff with Mindfulness

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Improve the Behavior of Prisoners and Prison Staff with Mindfulness

 

By John M. de Castro, Ph.D.

 

“I have seen how men in maximum security prison were able to support not only their own resilience, but also that of their guards, nurses, and other prison staff, through the practice of meditation, mindfulness, and deliberate kindness.” – Doug Carnine

 

Around 2 ¼ million people are incarcerated in the United States. Even though prisons are euphemistically labelled correctional facilities very little correction actually occurs. This is supported by the rates of recidivism. About three quarters of prisoners who are released commit crimes and are sent back to prison within 5-years. The lack of actual treatment for the prisoners leaves them ill equipped to engage positively in society either inside or outside of prison. Hence, there is a need for effective treatment programs that help the prisoners while in prison and prepares them for life outside the prison.

 

Contemplative practices are well suited to the prison environment. Mindfulness training teaches skills that may be very important for prisoners. In particular, it puts the practitioner in touch with their own bodies and feelings. It improves present moment awareness and helps to overcome rumination about the past and negative thinking about the future. It also relieves stress and improves overall health and well-being. Finally, mindfulness training has been shown to be effective in treating depression, anxiety, and anger. It has also been shown to help overcome trauma in male prisoners.

 

In today’s Research News article “Mindfulness-Based Stress Reduction in Prison: Experiences of Inmates, Instructors, and Prison Staff.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745607/), Bouw and colleagues examine the effectiveness of the Mindfulness-Based Stress Reduction (MBSR) program for prisoners. They recruited male prisoners, staff, and instructors from prisons in the Netherlands where the prisoners had attended an MBSR program. The MBSR program consisted of 8 weekly 2-hour group sessions involving meditation, yoga, body scan, and discussion. The prisoners were also encouraged to perform practice on their own for 45 minutes for 6 days per week.

 

The prisoners were administered a semi-structured interview to obtain the prisoners’ views of level of satisfaction and challenges regarding the program as well as potential effects on stress responsivity, coping style, impulse control, aggression, and self-esteem. The staff members and instructors were also interviewed about the effects or changes they observed in the inmates who underwent the intervention. The prisoners were highly appreciative of the program with 82% attending all MBSR sessions and 64% completing all homework assignments.

 

The prisoners reported that after the program they had significant decreases in both the frequency and intensity of experiencing anger, that they were better able to handle the anger when it did arise, and were more likely to seek solutions to the situation that evoked the anger. They also reported a significant reduction in their reactions to stress, that they were more likely to be relaxed, and less likely to be sad or silent after stress. The prisoners also reported that they were more likely to employ cognitive-oriented coping styles and less emotion-oriented coping styles after the Mindfulness-Based Stress Reduction (MBSR) program. Finally, the prisoners reported a significant increase in self-esteem. The prison staff, and instructors reported that the prisoners had overall improvements in their behavior after the MBSR program including reduced stress responses, anger, aggressive behavior, and hostility and increased self-esteem, emotional stability, dealing with difficult emotions, problem solving skills, and regulation of aggression.

 

It has to be recognized that there was no control, comparison, condition. As such the results are open to confounding factors such as demand characteristics, placebo effects, time-based changes, etc. Nevertheless, the results are very encouraging. Even if they are due to confounding factors rather than the Mindfulness-Based Stress Reduction (MBSR) program, there was a significant improvement in the prisoners. From a practical standpoint that was the intent of the program in the first place.

 

So, improve the behavior of prisoners and prison staff with mindfulness.

 

“By working with both prisoners and correctional facilities professionals, mindfulness programs systematically transform the impact of our criminal justice system. Through cultivating greater awareness and compassion, mindfulness “encourages a shift away from fear-based and often anti-social or criminal strategies for meeting needs” – Prison Mindfulness Institute

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Bouw, N., Huijbregts, S., Scholte, E., & Swaab, H. (2019). Mindfulness-Based Stress Reduction in Prison: Experiences of Inmates, Instructors, and Prison Staff. International journal of offender therapy and comparative criminology, 63(15-16), 2550–2571. doi:10.1177/0306624X19856232

 

Abstract

Mindfulness intervention aims to reduce stress and to improve physical and mental health. The present study investigated feasibility and effectiveness of mindfulness intervention in a prison context, in both a qualitative and quantitative fashion. Specifically, the mindfulness-based stress reduction (MBSR) intervention was investigated, in a retrospective pre–post design, in five Dutch prisons. Twenty-two inmates (out of 25 approached, mean age: 40.1 years (SD = 11.1), convicted of murder, manslaughter, sexual offenses, drug offenses, robbery with violence, and/or illegal restraint/kidnap, and sentenced to incarceration between 15 and 209 months (M = 5.5 years; SD = 3.8) took part in a semistructured interview after completion of the MBSR intervention. The interviews addressed level of satisfaction and challenges regarding the MBSR intervention as well as potential effects on stress responsivity, coping style, impulse control, aggression, and self-esteem. Ten staff members and four MBSR instructors were interviewed about their own practical issues experienced while providing or facilitating the MBSR intervention, and about the effects or changes they observed in the inmates who underwent the intervention. Both participants and instructors/prison staff reported improvements in all of the addressed domains and expressed satisfaction with the intervention. Challenges were mainly identified in practical issues regarding the organization of the intervention sessions. Future studies should investigate mindfulness in longitudinal randomly controlled designs, should strive for a multi-method approach, and distinguish inmates according to personality characteristics.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745607/

 

Improve the Brain’s Attentional Networks with Mindfulness

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Improve the Brain’s Attentional Networks with Mindfulness

 

By John M. de Castro, Ph.D.

 

“MBSR and RR body scans both induced a common increased functional connectivity between the brain’s ventromedial prefrontal cortex, which plays a role in attention.” – GORAMA

 

The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity.  Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread area. and have found that meditation practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits. These brain changes with mindfulness practice are important and need to be further investigates.

 

In today’s Research News article “Mindfulness-Based Stress Reduction-related changes in posterior cingulate resting brain connectivity.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778831/), Kral and colleagues recruited healthy meditation-naïve adults and randomly assigned them to 8 weeks of Mindfulness-Based Stress Reduction (MBSR) program, 8 weeks of a Health Education Program, or to a wait-list control condition. The MBSR program consisted of 8 weekly group sessions involving meditation, yoga, body scan, and discussion. The participants were also encouraged to perform daily practice at home. The amount of home practice time was recorded. Before and after the 8-week intervention they were measured for emotional styles and participated in 14 days of experience sampling with 6 to 8 prompts per day via cellphone to indicate attention to task or mind wandering. They also underwent brain scanning with functional Magnetic Resonance Imaging (fMRI) before and after the intervention and 5.5 months later.

 

They found that in comparison to baseline and the health education and wait-list control groups, the participants who underwent the Mindfulness-Based Stress Reduction (MBSR) program had a significant increase in the functional connectivity between the posterior cingulate cortex and the dorsomedial prefrontal cortex. They also found that the higher the self-reported attention levels and the greater the number of days of practice the MBSR participants engaged in, the greater the increase in functional connectivity. The connectivity increases and the relationships with attention and practice were no longer significant at the 5.5-month follow-up. There were no significant changes in mind-wandering.

 

These results are interesting and suggest that participation in the Mindfulness-Based Stress Reduction (MBSR) program produces short-term changes in the brain’s system that underlies executive function and attention (the posterior cingulate cortex and the dorsomedial prefrontal cortex). The results further suggest that the amount of change in the brain system is associated with attentional changes and the amount of practice.

 

That mindfulness training in general and Mindfulness-Based Stress Reduction (MBSR) in particular improves attention and the neural systems underlying attention and executive function have been previously demonstrated. The present study demonstrates that these changes are related to the amounts of continuing practice suggesting the importance of practice outside of formal training sessions.

 

So, improve the brain’s attentional networks with mindfulness.

 

“mindfulness meditation decreases activity in the part of the brain that is in charge of mind-wandering and self-centeredness. Although we all struggle with taming that Monkey Mind, meditators are better at snapping out of it when the brain gets into a cycle of overthinking or negativity.” –  Jaime Carlo-Casellas

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Kral, T., Imhoff-Smith, T., Dean, D. C., Grupe, D., Adluru, N., Patsenko, E., … Davidson, R. J. (2019). Mindfulness-Based Stress Reduction-related changes in posterior cingulate resting brain connectivity. Social cognitive and affective neuroscience, 14(7), 777–787. doi:10.1093/scan/nsz050

 

Abstract

Mindfulness meditation training has been shown to increase resting-state functional connectivity between nodes of the frontoparietal executive control network (dorsolateral prefrontal cortex [DLPFC]) and the default mode network (posterior cingulate cortex [PCC]). We investigated whether these effects generalized to a Mindfulness-Based Stress Reduction (MBSR) course and tested for structural and behaviorally relevant consequences of change in connectivity. Healthy, meditation-naïve adults were randomized to either MBSR (N = 48), an active (N = 47) or waitlist (N = 45) control group. Participants completed behavioral testing, resting-state fMRI scans and diffusion tensor scans at pre-randomization (T1), post-intervention (T2) and ~5.5 months later (T3). We found increased T2–T1 PCC–DLPFC resting connectivity for MBSR relative to control groups. Although these effects did not persist through long-term follow-up (T3–T1), MBSR participants showed a significantly stronger relationship between days of practice (T1 to T3) and increased PCC–DLPFC resting connectivity than participants in the active control group. Increased PCC–DLPFC resting connectivity in MBSR participants was associated with increased microstructural connectivity of a white matter tract connecting these regions and increased self-reported attention. These data show that MBSR increases PCC–DLPFC resting connectivity, which is related to increased practice time, attention and structural connectivity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778831/

 

Improve Chronic Obstructive Pulmonary Disease (COPD) Symptoms with Qigong

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Improve Chronic Obstructive Pulmonary Disease (COPD) Symptoms with Qigong

 

By John M. de Castro, Ph.D.

 

“Along with traditional medical treatments, pulmonary exercise has been utilized to increase endurance during physical activity and decrease breathlessness.  Reports using TaiQi and Qigong have shown better functional capacity and pulmonary function in patients with COPD.” – Ryan Killarney

 

Chronic Obstructive Pulmonary Diseases (COPD) are progressive lung diseases that obstruct airflow. The two main types of COPD are chronic bronchitis and emphysema. COPD is very serious being the third leading cause of death in the United States, over 140,000 deaths per year and the number of people dying from COPD is growing. More than 11 million people have been diagnosed with COPD, but an estimated 24 million may have the disease without even knowing it. COPD causes serious long-term disability and early death. Symptoms develop slowly. Over time, COPD can interfere with the performance of routine tasks and is thus a major cause of disability in the United States. COPD is not contagious. Most of the time, treatment can ease symptoms and slow progression.

 

There is no cure for Chronic Obstructive Pulmonary Diseases (COPD). Treatments include lifestyle changes, medicine, bronchodilators, steroids, pulmonary rehabilitation, oxygen therapy, and surgery. They all attempt to relieve symptoms, slow the progress of the disease, improve exercise tolerance, prevent and treat complications, and improve overall health. Mindful Movement practices such Tai Chi and qigong are ancient Chinese practices involving mindfulness and gentle movements. They are easy to learn, safe, and gentle. So, it may be appropriate for patients with COPD who lack the ability to engage in strenuous exercises to engage in these gentle practices.

 

In today’s Research News article “Effect of Qigong on self-rating depression and anxiety scale scores of COPD patients: A meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708806/), Wu and colleagues review, summarize, and perform a meta-analysis of the published research findings of the effectiveness of Qigong practice in the treatment of Chronic Obstructive Pulmonary Diseases (COPD). They found 6 published randomized controlled trials including a total of 415 participants.

 

They report that the research studies found that Qigong practice produced significant improvements in lung function and significant reductions in anxiety and depression in the patients with Chronic Obstructive Pulmonary Diseases (COPD). It is not known if the improvement in lung function was responsible for the mood improvements in the patients or if this was an independent effect of  Qigong practice. Since Qigong is usually practiced in groups, the increased socialization may also have been responsible for the improvements in mood.

 

These are interesting and important findings. Qigong practice is a very gentle exercise that only mildly increases respiration and as such it is surprising that there were such marked improvements in lung function. But the results clearly suggest that Qigong practice is an excellent safe and effective treatment for Chronic Obstructive Pulmonary Diseases (COPD) improving the patients physical and psychological well-being.

 

So, improve Chronic Obstructive Pulmonary Disease (COPD) symptoms with Qigong.

 

“The gentle movements of tai chi can improve the lives and boost the exercise endurance of people with chronic obstructive pulmonary disease.” – Matt McMillen

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Wu, J. J., Zhang, Y. X., Du, W. S., Jiang, L. D., Jin, R. F., Yu, H. Y., … Han, M. (2019). Effect of Qigong on self-rating depression and anxiety scale scores of COPD patients: A meta-analysis. Medicine, 98(22), e15776. doi:10.1097/MD.0000000000015776

 

Abstract

Objective:

To explore the clinical efficacy and safety of Qigong in reducing the self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores of patients with chronic obstructive pulmonary disease (COPD).

Methods:

We searched CNKI, Wan fang, Chongqing VIP, China Biology Medicine disc, PubMed, Cochrane Library, and EMBASE for studies published as of Dec 31, 2018. All randomized controlled trials of Qigong in COPD patients, which met the inclusion criteria were included. The Cochrane bias risk assessment tool was used for literature evaluation. RevMan 5.3 software was used for meta-analysis.

Results:

Six studies (combined n = 415 patients) met the inclusion criteria. Compared with conventional therapy alone, Qigong in combination with conventional therapy significantly improved the following outcome measures: SDS score [mean difference (MD) −3.99, 95% CI (−6.17, −1.82), P < .001, I2 = 69%]; SAS score[MD −4.57, 95% CI (−5.67, −3.48), P < .001, I2 = 15%]; forced expiratory volume in one second/prediction (FEV1% pred) [MD 3.77, 95% CI (0.97,6.58), P < .01, I2 = 0]; forced expiratory volume in one second (FEV1) [MD 0.21, 95% CI (0.13, 0.30), P < .001, I2 = 0%]; forced vital capacity (FVC) [MD 0.28, 95% CI (0.16, 0.40), P < .001, I2 = 0]; 6-minute walk test (6MWT) distance [MD 39.31, 95% CI (18.27, 60.34), P < .001, I2 = 32%]; and St. George’s Respiratory Questionnaire (SGRQ) total score [MD −11.42, 95% CI (−21.80, −1.03), P < .05, I2 = 72%].

Conclusion:

Qigong can improve the SDS and SAS scores of COPD patients, and has auxiliary effects on improving lung function, 6MWT distance, and SGRQ score.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708806/

 

Brain Activity Predicts the Effectiveness of Dialectical Behavior Therapy for Borderline Personality Disorder

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Brain Activity Predicts the Effectiveness of Dialectical Behavior Therapy for Borderline Personality Disorder

 

By John M. de Castro, Ph.D.

 

“Dialectical behavior therapy (DBT). . . is a type of psychotherapy, sometimes called “talk therapy,” used to treat borderline personality disorder (BPD). DBT is a form of cognitive behavioral therapy (CBT).” – Kristalyn Salters-Pedneault

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness.

 

The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. It is unknown how Dialectical Behavior Therapy may interact with brain systems to improve the responsiveness of Borderline Personality Disorder (BPD) to Dialectical Behavior Therapy (DBT).

 

In today’s Research News article “Individualized treatment response prediction of dialectical behavior therapy for borderline personality disorder using multimodal magnetic resonance imaging.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749487/), Schmitgen and colleagues recruited female patients suffering from Borderline Personality Disorder (BPD) who were treated with a 12-week program of Dialectical Behavior Therapy (DBT). They were classified into patients who had significantly benefited from treatment (responders) and those who did not (non-responders). Prior to the therapy the participants underwent functional Magnetic Resonance Imaging (fMRI) of their brains while performing cognitive reappraisal, sensory distraction and cognitive distraction tasks. They were also measured for BPD symptom severity, emotion regulation, dissociative experiences, anxiety, depression, and working memory.

 

They found that before treatment responders had significantly higher levels of borderline symptoms and borderline severity and higher anxiety levels than non-responders. They also found that activation of the amygdala and parahippocampus areas during a cognitive reappraisal task, along with borderline personality disorder severity and the gray matter volume of the amygdala produced the best predictors of responders vs. non-responders.

 

It appears that Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder (BPD) works best with patients who have the most severe symptoms and whose amygdala and parahippocampus areas are largest and respond most to a cognitive reappraisal task. These areas are associated with the brain systems underlying emotion regulation. Hence, the results suggest that particularly severe borderline patients whose brains respond best to emotional stimuli are the best responders to DBT. This suggests that the patients whose brains are best able to regulate emotions respond best to DBT.

 

Hence, brain activity predicts the effectiveness of Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder (BPD).

 

“one thing that has really helped in my recovery process, I would say dialectical behavior therapy. I eat, sleep and breathe DBT. I can give you a damn good crash course in mindfulness, which is a core concept in DBT. I can teach you about self-validation. I can spoon-feed you lessons and lessons on interpersonal effectiveness. DBT has truly been a gift to me.” – Borderline Beauty

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Schmitgen, M. M., Niedtfeld, I., Schmitt, R., Mancke, F., Winter, D., Schmahl, C., & Herpertz, S. C. (2019). Individualized treatment response prediction of dialectical behavior therapy for borderline personality disorder using multimodal magnetic resonance imaging. Brain and behavior, 9(9), e01384. doi:10.1002/brb3.1384

 

Abstract

Introduction

Individualized treatment prediction is crucial for the development and selection of personalized psychiatric interventions. Here, we use random forest classification via pretreatment clinical and demographical (CD), functional, and structural magnetic resonance imaging (MRI) data from patients with borderline personality disorder (BPD) to predict individual treatment response.

Methods

Before dialectical behavior therapy (DBT), 31 female patients underwent functional (three different emotion regulation tasks) and structural MRI. DBT response was predicted using CD and MRI data in previously identified anatomical regions, which have been reported to be multimodally affected in BPD.

Results

Amygdala and parahippocampus activation during a cognitive reappraisal task (in contrasts displaying neural activation for emotional challenge and for regulation), along with severity measures of BPD psychopathology and gray matter volume of the amygdala, provided best predictive power with neuronal hyperractivities in nonresponders. All models, except one model using CD data solely, achieved significantly better accuracy (>70.25%) than a simple all‐respond model, with sensitivity and specificity of >0.7 and >0.7, as well as positive and negative likelihood ratios of >2.74 and <0.36 each. Surprisingly, a model combining all data modalities only reached rank five of seven. Among the functional tasks, only the activation elicited by a cognitive reappraisal paradigm yielded sufficient predictive power to enter the final models.

Conclusion

This proof of principle study shows that it is possible to achieve good predictions of psychotherapy outcome to find the most valid predictors among numerous variables via using a random forest classification approach.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749487/

 

Increase Self-Compassion and Decrease Mind Wandering in Depression with Mindfulness

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Increase Self-Compassion and Decrease Mind Wandering in Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

“MBCT program is a group intervention that allows participants to become aware of how conditioned patterns of mind and mood can trigger depression relapse and sustain current symptoms of depression.  Through the practice of mindful awareness, they develop the capacity to mindfully disengage from distressing moods and negative thoughts.” – Center for Mindfulness in Medicine

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time.

 

Mindfulness-Based Cognitive Therapy (MBCT) is an alternative treatment to drugs that was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT has been found to be effective in treating depression. The exact mechanisms by which MBCT improves depression need exploration.

 

In today’s Research News article “Compassionate Hearts Protect Against Wandering Minds: Self-compassion Moderates the Effect of Mind-Wandering on Depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426326/), Greenberg and colleagues recruited depressed adults and randomly assigned them to receive either 8 weekly 2-hour sessions of Mindfulness-Based Cognitive Therapy (MBCT) or to a wait list control condition. MBCT participants were also asked to practice at home. All participants continued to receive their usual treatments. They were measured before and after treatment for depression, self-compassion, and mind wandering.

 

They found that prior to treatment the higher the levels of depression, the higher the levels of mind wandering and the lower the levels of self-compassion and that the higher the levels of self-compassion the lower the levels of mind wandering. They also found that participants who were low in mind wandering were significantly lower in depression, but only for participants who were also low in self-compassion. For those high in self-compassion there was no relationship between mind wandering and depression. Only those participants who were both low in self-compassion and high in mind wandering were depression scores high.

 

Compared to baseline and the wait-list controls, participants who received Mindfulness-Based Cognitive Therapy (MBCT) had significantly greater reductions in depression and mind wandering and increases in self-compassion.  They also found that the higher the levels of self-compassion at the beginning of training the larger the improvement in depression produced by MBCT. The improvements in depression were also associated with improvements in mind wandering.

 

The study reveals that self-compassion moderates the relationship of mind wandering with depression such that mind wandering is only associated with depression when self-compassion is low. In other words, when a participant has low levels of compassion for themselves they are vulnerable to the ability of a wandering mind to make depression worse. Mindfulness-Based Cognitive Therapy (MBCT) was shown to improve depression, mind wandering, and self-compassion and the degree of impact of MBCT on depression was dependent on the levels of self-compassion, with high self-compassion associated with greater improvement.

 

So, self-compassion appears to be a critical variable in the relationship of mind wandering with depression and the effectiveness of MBCT on depression. This further suggests that training in self-compassion may be able to help reduce depression and improve the impact of mindfulness-based treatments on depression.

 

So, increase self-compassion and decrease mind wandering in depression with mindfulness.

 

“ When you’re struggling with depression, the last thing you want to do is be self-compassionate. But this is precisely what can help.” – Margarita Tartakovsky

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Greenberg, J., Datta, T., Shapero, B. G., Sevinc, G., Mischoulon, D., & Lazar, S. W. (2018). Compassionate Hearts Protect Against Wandering Minds: Self-compassion Moderates the Effect of Mind-Wandering on Depression. Spirituality in clinical practice (Washington, D.C.), 5(3), 155–169. doi:10.1037/scp0000168

 

Abstract

Depression is associated with high levels of mind-wandering and low levels of self-compassion. However, little is known about whether and how these two factors interact with one another to influence depressive symptoms. The current study examined the interaction between mind-wandering, self-compassion and depressive symptoms in a depressed sample and tested the effects of an eight-week Mindfulness Based Cognitive Therapy (MBCT) program on these constructs. At baseline, mind-wandering was associated with higher depressive symptoms only among individuals with low self-compassion. Self-compassion additionally predicted depressive improvement. As expected, MBCT increased self-compassion and reduced mind-wandering compared to a treatment-as-usual control group. Overall, longitudinal changes in self-compassion produced a moderation effect similar to the one at baseline so that increases in mind-wandering were associated with increases in depressive symptoms only among those who decreased in self-compassion. Results provide the first evidence that self-compassion can protect against the deleterious effects of mind-wandering among depressed participants, both at baseline and longitudinally. Findings also suggest that self-compassion is an effective predictor of depressive improvement. Finally, MBCT is effective not only at reducing depressive symptoms, but also at targeting protective and risk factors associated with depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426326/

 

Secret of Happiness

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Nunchi

 

I read a wonderful article in the New York Times by Euny Hong entitled “The Korean Secret to Happiness and Success” (https://www.nytimes.com/2019/11/02/opinion/sunday/nunchi.html). It emphasizes the impact of the Korean word “nunchi” on their world view and their way of life. “Nunchi” is literally translated as “eye measure.” It suggests that every situation should be seen as a whole and the individual’s actions should be appropriate for the entire human context.

 

The fact is that most human behavior is affected mainly by a few aspects of the situation that the individual deems particularly salient and important. These might be people who are particularly important, or special friends or family, or enemies. Although this to some extent makes sense, it results in relegating everything and everyone else to the background. The totality of the situation is lost.

 

To students of mindfulness, it should be apparent that “nunchi” is the same as present moment awareness. It is being totally conscious of what is going on in the immediate environment. It is also non-judgmental, perceiving everything just as it is. But it is more in that the interrelationships of all things, what the Buddha called “interdependent co-arising” has to be seen, “eye measured.” It involves seeing the total picture as a gestalt, with not only the immediate components but also how they all interrelate.

 

There’s a Korean saying that “half of social life is nunchi.” This implies that seeing the entire social context in total in the present moment is extremely important to successfully navigating the social situation. When apprising a room full of people, the practice of “nunchi” would dictate taking in the whole scene and feeling the mood of the entire room, be it celebratory, somber, gleeful, sad, angry, etc.. Each individual in the room is then seen within the context. If there’s an angry sense to the room, the behavior of each person is seen against that backdrop. If one individual is neutral, they will actually be viewed as positive, as neutral is in the positive direction from angry. This better allows the individual to react and interact with the person with greater understanding and a more accurate interpretation of the behavior, which, in turn, allows for more calibrated and effective responses. Others tend to like better and interact more with people who practice “nunchi.”

 

In the process of “eye measuring” there is little opportunity for talking. So, “nunchi” usually involves more listening and less talking. It’s been said that we learn nothing new when we’re speaking. So, by practicing “nunchi” and listening more we have the opportunity to learn and be better positioned for future interactions. People respond very positively when they feel that they are being heard. Listening is a rare yet extremely valuable skill that is promoted by the practice of “nunchi.”

 

“Nunchi” allows for better identification of what can be controlled and what can’t. Seeing things and people as they are and as a whole should make it clear what kinds of impacts our behavior can have and what are the likely consequences of those behaviors. In other words, being completely in the present moment strengthens the ability to intervene for the good.

 

The Korean’s clearly understand the importance of present moment awareness and by making it an important word in the language, “nunchi”, make it front and center in their minds. They have long recognized it importance for effective interactions. The mindfulness revolution in the western world is simply helping us catch up.

 

So, practice “nunchi”, being mindful and aware, and be happier.

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Reduce the Complexity of Brain Activity with Meditation

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Reduce the Complexity of Brain Activity with Meditation

 

By John M. de Castro, Ph.D.

 

“intensive and continued meditation practice is associated with enduring improvements in sustained attention.” – Anthony Zanesco

 

There has accumulated a large amount of research demonstrating that meditation practice has significant benefits for psychological, physical, and spiritual wellbeing. One way that meditation practices may produce these benefits is by altering the brain. The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. In other words, meditation practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits.

 

It is important to understand what are the exact changes in the brain that are produced by meditation. Studies of changes in brain activity with meditation suggest that meditators have more complicated information processing going on in their nervous systems at rest but during meditation greatly simplify that activity. But there are, a wide variety of meditation techniques that may have different consequences for brain changes. One category of these techniques is focused attention meditation, where the individual practices paying attention to a single meditation object, learns to filter out distracting stimuli, including thoughts, and learns to stay focused on the present moment, filtering out thoughts centered around the past or future.

 

In today’s Research News article “Controlling the Temporal Structure of Brain Oscillations by Focused Attention Meditation.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585826/), Irrmischer and colleagues examine the changes in brain activity with focused meditation. They recruited experienced meditators (> 5 years of experience) and meditation naïve control participants. They measured their brain activity with an Electroencephalogram (EEG) after eye closed rest and after 5 minutes of focused meditation. In a second study they recruited experienced meditators and healthy control participants. They again measured their brain activity with an Electroencephalogram (EEG) during and after eye closed rest and during and after 5 minutes of focused meditation.

 

In study 1, compared to after a rest condition, after focused meditation there were significant changes in cognitive content with a reduction in theory of mind, planning, sleepiness, verbal thought, health concerns, and discontinuity of mind, and increase in somatic awareness. Also, in comparison to baseline and the control participants, during focused meditation there was a reduction in the complexity of the brain activity with a reduction in long-range temporal correlations across every frequency band and across brain areas. These differences in the EEG were confirmed in study 2 and they found that after 1 year of meditation training there was a further significant reduction in the complexity of brain activity with a reduction in long-range temporal correlations. These differences were also present after eyes closed rest without meditation suggesting that there was an overall reduction in neural activity complexity.

 

These results are interesting and suggest that meditation changes the brain over time to produce less complexity in brain activity. This is similar to previous findings using a different analytic technique that meditation reduces the complexity of neural processing. It is not known but this decrease in complexity of brain activity may be reflective of the ability of meditation practice to increase attention and decrease mind wandering. Greater focus with less distraction would reduce the complexity of brain activity. This would make the brain more efficient and better able to carry out its important cognitive functions. These cognitive changes were reflected in the cognitive contents after meditation.

 

So, reduce the complexity of brain activity with meditation.

 

“bringing attention back to the breath each time you feel your mind wandering during meditation helps strengthen the brain’s neural circuitry for focus.” – Nicole Bayes-Fleming

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Irrmischer, M., Houtman, S. J., Mansvelder, H. D., Tremmel, M., Ott, U., & Linkenkaer-Hansen, K. (2018). Controlling the Temporal Structure of Brain Oscillations by Focused Attention Meditation. Human brain mapping, 39(4), 1825–1838. doi:10.1002/hbm.23971

 

Abstract

Our focus of attention naturally fluctuates between different sources of information even when we desire to focus on a single object. Focused attention (FA) meditation is associated with greater control over this process, yet the neuronal mechanisms underlying this ability are not entirely understood. Here, we hypothesize that the capacity of attention to transiently focus and swiftly change relates to the critical dynamics emerging when neuronal systems balance at a point of instability between order and disorder. In FA meditation, however, the ability to stay focused is trained, which may be associated with a more homogeneous brain state. To test this hypothesis, we applied analytical tools from criticality theory to EEG in meditation practitioners and meditation‐naïve participants from two independent labs. We show that in practitioners—but not in controls—FA meditation strongly suppressed long‐range temporal correlations (LRTC) of neuronal oscillations relative to eyes‐closed rest with remarkable consistency across frequency bands and scalp locations. The ability to reduce LRTC during meditation increased after one year of additional training and was associated with the subjective experience of fully engaging one’s attentional resources, also known as absorption. Sustained practice also affected normal waking brain dynamics as reflected in increased LRTC during an eyes‐closed rest state, indicating that brain dynamics are altered beyond the meditative state. Taken together, our findings suggest that the framework of critical brain dynamics is promising for understanding neuronal mechanisms of meditative states and, specifically, we have identified a clear electrophysiological correlate of the FA meditation state.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585826/

 

Meditation Practice is Growing Rapidly Among Children and Adolescents

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Meditation Practice is Growing Rapidly Among Children and Adolescents

 

By John M. de Castro, Ph.D.

 

“It’s almost as though meditation was designed for kids. They just ‘get it’ – there is this elasticity and freedom in their minds which allows them to be present in the moment and free from any external thoughts or pressures.” – Andy Puddicombe

 

Childhood is a miraculous period during which the child is dynamically absorbing information from every aspect of its environment. This occurs almost without any intervention from the adults as the child appears to be programmed to learn. It is here that behaviors, knowledge, skills, and attitudes are developed that shape the individual. Adolescence is a time of mental, physical, social, and emotional growth. It is during this time that higher levels of thinking, sometimes called executive function, develops.

 

Childhood and adolescence can be difficult times, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child or adolescent can feel overwhelmed and unable to cope with all that is required.

 

Mindfulness training for children and adolescents has been shown to have very positive effects. These include academic, cognitive, psychological, and social domains. Mindfulness training has been shown to improve emotion regulation and to benefit the psychological and emotional health of adolescents. Importantly, mindfulness training with children and adolescents appears to improve the self-concept, improves attentional ability and reduces stress. These benefits are becoming more widely appreciated and should have led to greater numbers of children and adolescents practicing meditation.

 

In today’s Research News article “Prevalence, patterns, and predictors of meditation use among U.S. children: Results from the National Health Interview Survey.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502253/), Wang and Gaylord analyzed the data from the 2017 National Health Interview Survey, separating that  obtained from children and adolescents. They recorded meditation use, health records, and health care utilization.

 

They found that 7.4% of the children and adolescents practiced meditation. This was a very large increase from the 1.6% that was found in 2012. 1.0% of the children and adolescents used mantra meditation, 1.6% used mindfulness meditation, 4.0% used spiritual meditation, and 3.0% practiced meditation as part of yoga, tai chi, or qigong. They also found that meditation was more likely to be used by youths whose parent completed some college, had headaches, depression, or a respiratory allergy, and who lived in the western U.S. Children or adolescents who had medical conditions were more likely to use mindfulness meditation. Surprisingly, neither age, gender, race, nor socioeconomic status was associated with different frequencies of meditation use.

 

These results are interesting and document the tremendous increase in the acceptability and utilization of meditation practice by children and adolescents over the last 5 years. This has probably occurred due to the increased recognition of the benefits of mindfulness practices for the physical and psychological health of children and adolescents and it’s increased practice in schools. It will be interesting to see if this trend continues over the next 5 years.

 

“Our kids’ brains are tired, and children of all ages really need opportunities where they can take time out each day “unplugged” to relax and focus. Meditation offers this break and helps kids function more effectively and clearly.” – Healthy Children

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Wang, C., Li, K., & Gaylord, S. (2019). Prevalence, patterns, and predictors of meditation use among U.S. children: Results from the National Health Interview Survey. Complementary therapies in medicine, 43, 271–276. doi:10.1016/j.ctim.2019.02.004

 

Abstract

Objectives:

The purpose of the study is to examine the characteristics of various types of meditation use (i.e., mantra, mindful, and spiritual meditation) among U.S. children.

Methods:

Using 2017 National Health Interview Survey, we examined the prevalence, patterns, and potential predictors of meditation use among U.S. children aged 4 to 17 years. Descriptive statistics, Wald F chi-square test, and multivariable logistic regression were used for data analysis (n = 6925).

Results:

Overall meditation use has increased substantially from 1.6% in 2012 to 7.4% in 2017 among children in the US. Children with chronic medical conditions were more likely to use mindful meditation (Adjusted Odds Ratio (AOR) = 1.9–3.6, 95% CI [1.0–7.4]). Regularly taking prescription medication had an inverse relation with mantra meditation use (AOR = 0.4, 95% CI [0.2–0.9]). Children with delayed medical care due to access difficulties were more likely to use spiritual meditation, compared to those who did not (AOR = 1.7, 95% CI [1.1–2.6]).

Conclusions:

Meditation use has rapidly increased among U.S. children within the past few years. Future studies should explore the underlying reasons for this increase and its potential benefits for pediatric meditators.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502253/

 

Improve Physical and Mental Health in Trauma Victims with Bikram Yoga

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Improve Physical and Mental Health in Trauma Victims with Bikram Yoga

 

By John M. de Castro, Ph.D.

 

“The steamy temps “allow you to increase their range of motion and stretch deeper within each pose,” since heat makes muscles more pliable, says Numbers. Unlike stretching it out in a standard cool yoga studio, the heat will have you feeling like a pro and extending further than you thought you could.” – Aryelle Siclait

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. Trauma can produce troubling physical and psychological symptoms that need to be addressed. There are a number of therapies that have been developed to treat the effects of trauma. One of which, mindfulness training has been found to be particularly effective. Yoga practice is a mindfulness practice that has been shown to be helpful for trauma survivors.

 

Yoga is a mindfulness practice that has been shown to improve physical well-being and cardiovascular health. Bikram Yoga is somewhat unique yoga practice as it employs a set sequence of 26 poses (asanas) and two breathing exercises. It is practiced in a heated environment (105°F, 40.6°C, 40% humidity) and there is a unique programmed instructional dialogue. The hot environment is thought to soften the muscles making them more pliable and loosen the joints making them more flexible allowing the practitioner to go deeper into poses. The sweating that occurs is thought to help remove toxins and impurities.

 

In today’s Research News article “#MindinBody – feasibility of vigorous exercise (Bikram yoga versus high intensity interval training) to improve persistent pain in women with a history of trauma: a pilot randomized control trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714085/), Flehr and colleagues recruited adult pre-menopausal women who had persistent pain and who had experienced trauma. They were randomly assigned to receive 8 weeks of 3 sessions per week of Bikram Yoga (90 minutes) or High Intensity Interval Training (45 minutes). The women were measured before and after training for pain severity, pain interference with quality of life, health, anxiety, depression, perceived stress, disorders of extreme stress, self-efficacy, life stressors, mindfulness, body size, and electrocardiogram (EKG) measures.

 

They found that pain significantly decreased for both groups. On the other hand, Bikram Yoga produced significantly greater improvements in physical functioning, mental health, and heart rate variability with moderate to large effect sizes. No intervention related injuries were reported. Heart rate variability has been shown to measure greater parasympathetic nervous system activity reflecting better overall health.

 

The results suggest that although both programs produced decreased pain intensity, Bikram Yoga was superior to a comparable high intensity exercise in improving the physical and mental health of trauma survivors with persistent pain. A strength of the study is that the Bikram Yoga intervention was compared to another high intensity exercise program, thus reducing the likelihood of participant expectancy effects. Hence Bikram Yoga appears to be a safe and effective treatment for women who have experienced trauma. It would be interesting in the future to compare the Bikram Yoga program to a comparable yoga program practiced at room temperature.

 

So, improve physical and mental health in trauma victims with Bikram Yoga.

 

“Hot yoga addresses all aspects of physical fitness including muscular strength, endurance, flexibility and weight loss. . . . There is no other style of yoga that addresses the overall health of the body in such a comprehensive way.” – Peter Mason

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Flehr, A., Barton, C., Coles, J., Gibson, S. J., Lambert, G. W., Lambert, E. A., … Dixon, J. B. (2019). #MindinBody – feasibility of vigorous exercise (Bikram yoga versus high intensity interval training) to improve persistent pain in women with a history of trauma: a pilot randomized control trial. BMC complementary and alternative medicine, 19(1), 234. doi:10.1186/s12906-019-2642-1

 

Abstract

Background

The neurobiology of persistent pain shares common underlying psychobiology with that of traumatic stress. Modern treatments for traumatic stress often involve bottom-up sensorimotor retraining/exposure therapies, where breath, movement, balance and mindfulness, are used to target underlying psychobiology. Vigorous exercise, in particular Bikram yoga, combines many of these sensorimotor/exposure therapeutic features. However, there is very little research investigating the feasibility and efficacy of such treatments for targeting the underlying psychobiology of persistent pain.

Methods

This study was a randomized controlled trail (RCT) comparing the efficacy of Bikram yoga versus high intensity interval training (HIIT), for improving persistent pain in women aged 20 to 50 years. The participants were 1:1 randomized to attend their assigned intervention, 3 times per week, for 8 weeks. The primary outcome measure was the Brief Pain Inventory (BPI) and further pain related biopsychosocial secondary outcomes, including SF-36 Medical Outcomes and heart rate variability (HRV), were also explored. Data was collected pre (t0) and post (t1) intervention via an online questionnaire and physiological testing.

Results

A total of 34 women were recruited from the community. Analyses using ANCOVA demonstrated no significant difference in BPI (severity plus interference) scores between the Bikram yoga (n = 17) and the HIIT (n = 15). Women in the Bikram yoga group demonstrated significantly improved SF-36 subscale physical functioning: [ANCOVA: F(1, 29) = 6.17, p = .019, partial eta-squared effect size (ηp2) = .175 and mental health: F(1, 29) = 9.09, p = .005, ηp2 = .239; and increased heart rate variability (SDNN): F(1, 29) = 5.12, p = .013, ηp2 = .150, scores compared to the HIIT group. Across both groups, pain was shown to decrease, no injuries were experienced and retention rates were 94% for Bikram yoga and 75% for HIIT .

Conclusions

Bikram yoga does not appear a superior exercise compared to HIIT for persistent pain. However, imporvements in quality of life measures and indicator of better health were seen in the Bikram yoga group. The outcomes of the present study suggest vigorous exercise interventions in persistent pain cohorts are feasible.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714085/